Elizabeth Howell: How we can improve maternal healthcare -- before, during and after pregnancy
伊莉莎白 · 豪厄爾: 如何改善孕產婦的醫療保健——孕前、孕中、孕後
Elizabeth Howell is working to address maternal mortality in the United States. Full bio
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as a resident physician
of doctors and nurses
to save a woman's life.
a few hours before I arrived.
她剛產下一名健康的男嬰
became unresponsive,
and the patient was lifeless.
tried to bring her back to life,
was the father's piercing cry.
and the heart of everyone on that floor.
the happiest day of his life,
to be the worst day.
was an isolated incident,
死於妊娠相關的疾病
is actually higher
for women of color.
actually increased over the last decade,
我們孕產婦死亡率攀升
than any other country in the world.
高於世界上任何一個國家
that this new mother lost her life,
那位母親往生的那段時間
and training in the field,
by how little attention was paid
高品質的保健而感到吃驚
maternal health care.
not just for myself
was a civil rights attorney
for what we believe in.
were born in Jamaica,
the American Dream.
women of color were treated
在我們的醫療體系下
I felt a responsibility to stand up,
by our healthcare system.
on improving maternal health care.
causing seizures and strokes,
of maternal mortality in this country.
部分主要原因
is only the tip of the iceberg.
suffer a severe complication
有超過 100 位的女性
having one of these events.
會碰到其中的一項
called severe maternal morbidity,
and they're life-altering.
而且它們會改變人的一生
between 1.5 and two percent
每 400 萬次分娩中
that occur every year in this country
having a blood clot, a seizure, a stroke,
such as kidney failure,
that's frankly unforgivable
of these deaths and severe complications
死亡和嚴重併發症
and standard procedures
these bad outcomes from occurring
fancy new technology.
between hospitals.
in labor has really high blood pressure
在分娩過程中出現了高血壓
antihypertensive medication
blood loss during delivery,
分娩時的失血情況
and save a woman's life.
從而拯救產婦的生命
of these catastrophic events tomorrow,
這些悲慘事件的發生率
the quality of care
和產後的醫療照護品質
to what is supposed to be the standard,
提高到應有的標準
and severe complications way down.
死亡和嚴重併發症的機率
actually adopted these standards,
of Obstetricians and Gynecologists
healthcare organizations,
像我一樣的研究員和社區組織
and community organizations.
standard care practices
和醫療體系中
throughout the country.
is a program called
in Maternal Health, the AIM program.
即 AIM 計畫
and severe maternal morbidity rates
across the country.
和孕產婦重大疾病罹患率
a number of safety bundles
孕產婦死亡病因
preventable causes of a maternal death.
has the potential to reach
超過 50% 的分娩所需
protocols, procedures,
these conditions.
of a hemorrhage bundle.
需要有一台治療推車
might need in an emergency:
to measure blood loss:
collect these sponges and pads
assess how much blood has been lost.
crises protocols for massive transfusions
以及定期的培訓與演練
in the use of these types of bundles,
應用上已然成為急先鋒
saw a 21 percent reduction
醫療工具包的加州醫院
產婦人數減少了 21%
this bundle in the first year.
across the country is spotty or missing.
卻存在著良莠不齊或不完整的現象
of evidence-based practices
for women of color in the United States.
醫療差別待遇最為嚴重
機率是白人女性的 3 至 4 倍
to suffer a pregnancy-related death
who deliver in this country,
所有在美國妊娠的黑人女性
in the United States
drive these disparities,
黑人女性的死亡率
as compared to a white woman
白人女性高 2 倍
to suffer a severe pregnancy complication
機率比白人女性高 2 至 3 倍
that education was our salvation,
健康基準差距中
perinatal health measures,
are even more pronounced
more likely to die
than is a white woman.
are probably familiar with
沙隆 · 歐文醫生令人痛心的故事
of Dr. Shalon Irving,
who died following childbirth.
與預防中心的流行病學家
in ProPublica and NPR
和全國公共廣播電台報導
of hearing her mother speak.
racial and ethnic disparities in health.
所受到的醫療差別待遇
this was her first baby,
人生中第一個孩子
a complicated pregnancy,
and was discharged from the hospital.
from complications of high blood pressure.
by healthcare professionals
was not recognized.
is just one of many stories
in health and health care
醫療差別照護的故事之一
that the social determinants of health,
醫療保健的社會決定因素
教育、隔離的住宅區
segregated housing,
an additional underlying cause:
by clinicians in those three weeks,
in the setting of childbirth
of racial and ethnic disparities
and severe maternal morbidity
for a variety of reasons,
in a specific set of hospitals,
outcomes for both black and white women,
經常面臨更高的孕期風險
of all black women
會在這些特定醫院分娩
deliver in those same hospitals.
會選擇這些醫院
of having a life-threatening complication
具生命危險併發症的機率
in one hospital than another.
are more likely to deliver
面臨更高的風險就不足為奇了
of the black-white disparity.
差異的原因
social determinants of health
擁有真正公平的醫療照護
equitable health care in this country,
and they will take some time to resolve.
需要投入時間去解決
we can tackle quality of care.
across the care continuum
提供高品質的醫護服務
and reliable contraception
providing preconception care,
and optimize health.
high-quality prenatal and delivery care
postpartum and inter-pregnancy care
和兩次孕間期的保健
to have a healthy next baby
between life and death,
after having an elevated blood pressure
was her second pregnancy.
這是她的第二次懷孕
that had happened two years earlier,
in the last few weeks of her pregnancy,
感到身體不適
elevated blood pressures,
don't worry, you'll be fine.
你只是有點緊張罷了」
You're a little nervous."
for Maria last time.
認真傾聽了她的主訴
the signs and symptoms of preeclampsia
子癇前症的徵兆和症狀
if she was not feeling well,
sent her to the hospital.
ordered urgent lab tests.
to multiple different monitors
to her blood pressure,
to prevent a seizure.
so high it put her at risk for a stroke,
有引發中風的危險時
blood pressure in 15 minutes
according to the latest correct protocol.
給她正確的靜脈注射用藥
as a coordinated team
lowered her blood pressure.
a tragedy became a success story.
逆轉為成功的故事:
were controlled,
from the hospital,
the signs and symptoms of preeclampsia,
子癇前症的徵兆和症狀
her blood pressure checked,
特別是產後第一週
postpartum health and what to expect.
產後保健事項和可能發生的狀況
with her pediatrician
her blood pressure,
as a new mother.
解答其關心在意的問題
across the care continuum looks like,
該有的高品質醫療服務
standard care practices,
maternal morbidity rates would plummet.
和孕產婦重大疾病罹患率
would no longer be an embarrassment.
of unacceptably high rates
和嚴重產科併發症的發生率
complications during delivery
for moms, babies and families,
our poor performance on maternal mortality
孕產婦死亡率的報導
is within reach.
其實不難獲得
每個社區中的孕婦了嗎?
pregnant women from every community?
to ensure that when we do,
我們擁有充足的技術和實證基礎
ABOUT THE SPEAKER
Elizabeth Howell - Maternal health reformerElizabeth Howell is working to address maternal mortality in the United States.
Why you should listen
Elizabeth Howell is a physician, researcher and advocate committed to improving the health and well-being of women. She is an expert in quality-of-care and racial and ethnic disparities in maternal and child health. Her research focuses on the intersection between quality-of-care and disparities in maternal and infant mortality and morbidity, as well as postpartum depression and its impact on underserved communities.
A graduate of both Harvard Medical School and the Harvard Kennedy School, Howell is a pioneer in research in health equity. She has conducted extensive research on maternal morbidity and mortality in New York City and the significant racial and ethnic disparities that exist. She is a professor in the Departments of Obstetrics, Gynecology, and Reproductive Sciences and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. In addition, as the founding Director of the Blavatnik Family Women's Health Research Institute at Mount Sinai, Howell is building a competitive research program that advances the science of women's health across the life span. She has served on several expert committees for organizations including the National Academy of Medicine, National Institutes of Health, the Joint Commission and the American Congress of Obstetricians and Gynecologists.
Elizabeth Howell | Speaker | TED.com